Laparoscopic relocation of the ovaries after prior transposition

Abstract

Video Objective To describe the indications, surgical approaches and expected outcomes for ovarian transposition and highlight a case of ovarian relocation to the pelvis in a patient who underwent prior transposition. Setting A 34 year old patient with a history of metastatic spinal ependymoma underwent laparoscopic ovarian transposition prior to craniospinal radiation. Eleven years after her transposition, she was seen by reproductive endocrinology and infertility for preconception counseling and evaluation. Her follicle stimulating hormone levels were within normal limits, but her hysterosalpingogram demonstrated bilateral tubal isthmic occlusion. She was referred to minimally invasive gynecologic surgery for surgical consultation. Interventions The patient was taken to the operating room for operative laparoscopy, ovarian relocation to the pelvis and evaluation of her fallopian tubes. Intraoperative findings were notable for transposition of the bilateral ovaries and fallopian tubes to the lateral abdominal peritoneum. Adhesiolysis was performed to mobilize each ovary on its vascular pedicle. Without compromise to the ovarian blood supply, and in a tension-free manner, each ovary was sutured to the ipsilateral round ligament. Conclusion Laparoscopic ovarian transposition is an important surgical technique to aid preservation of ovarian function in reproductive aged women undergoing pelvic radiation. Gynecologic surgeons should be aware of the techniques to perform ovarian transposition, as well as relocation of the ovaries to the pelvis for future spontaneous or assisted reproduction. Knowledge of abdominal and pelvic anatomy, as well as proficiency in laparoscopic suturing are essential to perform ovarian transposition and relocation in a minimally invasive fashion.